scientific program • symposia - American Society for Reproductive ...

MATERIALS AND METHODS: Conservative management
with observation until maturity, symptom control, septum
resection and minimal surgical intervention. However, in
the setting of the anamolous genital tract, imaging can
be misguiding and surgical intervention to relieve patient
symptoms may be warranted.
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V-18 5:28 PM
LAPAROSCOPIC RESECTION OF A RECTOVAGINAL NODULE
OF ENDOMETRIOSIS IN ASSOCIATION WITH A UTERINE
MALFORMATION.
N. Vulliemoz, E. McVeigh, T. Child. Nuffield Department of
Obstetrics and Gynaecology, University of Oxford, Oxford,
Oxfordshire, United Kingdom.
OBJECTIVE: We present the case of a 25 year-old P0 woman
who was referred to our clinic for severe cyclical pelvic pain,
dyspareunia and dyschezia without per rectum bleeding.
On examination a 4-cm full thickness rectovaginal nodule
of endometriosis was seen with excruciating tenderness
on palpation. The cervix and the rest of the vagina looked
normal. The rectal examination was normal. The MRI
confirmed the rectovaginal nodule and the uterus was
described as bicornuate. After discussing the possible risks
associated with the surgery, the patient decided to undergo
a laser laparoscopy with excision of the rectovaginal
nodule.
DESIGN: Using CO2 laser, adhesiolysis is started. Both ureters
are dissected from the side wall to prevent injury. The
bowel is separated from the posterior wall of the uterus
until the rectovaginal nodule is identified. It is vaporized
with the CO2 laser. As the lesion involves the full thickness
of the vaginal wall, we open the vagina to excise the
nodule. The vagina is closed using simple interrupted
stitches of Monocryl 2.0. At the end of the surgery, there is
no bleeding and the rectovaginal space has been freed.
The patient was discharged day 3 post operatively without
complication. She was reviewed 6 weeks later with almost
complete resolution of symptoms. At 6 months there was no
symptomatic recurrence.
MATERIALS AND METHODS: In 2007 our Department
published a retrospective study looking at urological and
colorectal complications following surgery for rectovaginal
endometriosis. The cohort included 128 women with
histologically confirmed rectovaginal endometriosis
who underwent laparoscopic laser surgery. Major
complications occurred in four women (3%). Three women
developed fistulae and ureteric damage occurred in one
woman. Therefore radical laser excision of rectovaginal
endometriosis is a safe procedure that can give long-term
pain relief. The potential serious complications necessitate
careful and extensive counselling before the surgery.
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V-19 5:42 PM
ROBOTIC APPLICATIONS IN BENIGN ADNEXAL PATHOLOGY.
A. R. Gargiulo, D. Shah, S. S. Srouji. Center for Infertility and
Reproductive Surgery, Brigham and Women’s Hospital/
Harvard Medical School, Boston, MA.
OBJECTIVE: This video illustrates our recent surgical
experience with two separate cases of benign tumors of
the adnexa: a fibroadenoma of the tubal infundibulum
and a recurrent mature cystic teratoma of the ovary. In
both of these cases the use of the da Vinci robot was
felt to contribute distinct advantages in terms of fertility
VIDEO PROGRAM
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preservation over our standard laparoscopic techniques.
DESIGN: A 22 year old nuliiparous woman was referred to
us following a diagnostic laparoscopy where a presumably
benign solid tumor of the infundibulum was identified. We
performed a robot-assisted enucleation of the tumor with
microsurgical instrumentation and complete preservation of
the lumen.
A 30 year old nulliparous and woman with history of bilateral
open cystectomy and left laparoscopic stripping of mature
teratomata was referred to us for a recurrence in the
right ovary observed in preparation for an ART cycle. We
performed a robot-assisted laparoscopic stripping entirely in
a specimen pouch with no spill and with sparing of normal
ovarian tissue and hilar vessels.
MATERIALS AND METHODS: Use of the da Vinci robotic
platform in these two delicate cases made a difference
- in our opinion - in terms of our ability to preserve fertility.
Microsurgical capabilities allowed the pristine reconstruction
of a severely affected tubal infundibulum. Similarly, the pitch
and yaw at the wrist of standard robotic instruments allowed
us to comfortably complete an entire teratoma stripping
procedure in a specimen pouch and to limit coagulation of
the ovarian cyst bed.
It is our considerate opinion as experienced minimally
invasive reproductive surgeons that the above procedures
could certainly be performed by many with conventional
laparoscopy, but by very few with the same level of
accuracy and tissue preservation that is allowed by the
robotic platform.
This footage was intentionally submitted without verbal
commentary to let the images speak for themselves.
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V-20 5:48 PM
ROBOTICALLY ASSISTED OVARIAN TRANSPLANTATION.
M. Bedaiwy, E. Barakat, M. Catenacci, L. Carvalho, T.
Falcone. Obstetrics and Gynecology, Cleveland Clinic
Foundation, Cleveland, OH.
OBJECTIVE: To describe a technique for robotically assisted
transplantation of hemiovaries.
DESIGN: The ovarian cortex of the left over ovary was
removed and the fresh raw surface will be the recipient
site. The frozen hemovaries was thawed and orthotopically
transplanted to a freshly created medullary surface of
the remaining ovary using the surgical robot (Da-Vinci).
Transplantation was completed using 8-0 prolene stitches. 2
weeks later, the ovarian grafts were examined for viability,
harvested and fixed for histopathological examination. The
video could seen using the following link:
files.me.com/lehtinenvideography/kr8rd5.
MATERIALS AND METHODS: Robotically assistance may
facilitate transplantation of fresh or frozen-thawed hemiovaries.
It could also minimize the worm ischemia time. 8-0
or less prolene sutures should be used.
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V-21 6:02 PM
A SUCCESSFUL TWIN PREGNANCY AFTER ADNEXAL TORSION
ON EMBRYO TRANSFER DAY: THE IMPORTANCE OF A QUICK
DIAGNOSIS.
F. A. Padilla, S. Chedid, F. Ikeda. Chedid Grieco Medicina
Reprodutiva, Sao Paulo, Brazil.
OBJECTIVE: To report a case of unilateral adnexal torsion
8 hours after embryo transfer and the successful of the
twin pregnancy in this cycle due to quickly diagnosis and